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eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

24th January 2012, Tuesday

American College of Physicians: Common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high–value care

  1. Repeating screening ultrasonography for abdominal aortic aneurysm following a negative study
  2. Performing coronary angiography in patients with chronic stable angina with well–controlled symptoms on medical therapy or who lack specific high–risk criteria on exercise testing
  3. Performing echocardiography in asymptomatic patients with innocent–sounding heart murmurs, most typically grade–I–II/VI shot systolic, midpeaking murmurs that are audible along the left sternal border
  4. Performing routine periodic echocardiography in asymptomatic patients with mid aortic stenosis more frequently than every 3–5 years.
  5. Routinely repeating echocardiography in asymptomatic patients with mild mitral regurgitation and normal left ventricular size and function
  6. Obtaining electrocardiograms to screen for cardiac disease in patients at low to average risk for coronary artery disease
  7. Obtaining exercise electrocardiogram for screening in low–risk asymptomatic adults
  8. Performing an imaging stress test (echocardiographic or nuclear) as the initial diagnostic test in patients with known or suspected coronary artery disease who are able to exercise and have no testing electrocardiographic abnormalities that may interfere with interpretation of test results
  9. Measuring brain natriuretic peptide in the initial evaluation of patients with typical findings of heart failure.
  10. Annual lipid screening for patients not receiving lipid-lowering drug or diet therapy in the absence of reasons for changing lipid profiles.
  11. Using MRI rather than mammography as the breast cancer screening test of choice for average–risk women.
  12. In asymptomatic women with previously treated breast cancer, performing follow–up complete blood counts, blood chemistry studies, tumor marker studies, chest radiography, or imaging studies other than appropriate breast imaging.
  13. Performing dual–energy x–ray absorptiometry screening for osteoporosis in women younger than 65 years in the absence of risk factors.
  14. Screening low–risk individuals for hepatitis B virus infection.
  15. Screening for cervical cancer in low–risk women aged 35 years or older and in women who have had a total hysterectomy (uterus and cervix) for benign disease.
  16. Screening for colorectal cancer in adults older than 75 years or in adults with a life expectancy of less than 10 years.
  17. Repeating colonoscopy within 5 years of an index colonoscopy in asymptomatic patients found to have low–risk adenomas.
  18. Screening for colorectal cancer in adults older than 75 years or with a life expectancy of less than 10 years.
  19. Using CA–125 antigen levels to screen women for ovarian cancer in the absence of increased risk.
  20. Performing imaging studies in patients with nonspecific low back pain.
  21. Performing preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology.
  22. Ordering routine preoperative laboratory tests, including complete blood count, liver chemistry tests, and metabolic profiles, in otherwise healthy patients undergoing elective surgery.
  23. Performing preoperative coagulation studies in patients without risk factors or predisposing conditions for bleeding and with a negative history of abnormal bleeding.
  24. Performing serologic testing for suspected early Lyme disease.
  25. Performing serologic testing for Lyme disease in patients with chronic nonspecific symptoms and no clinical evidence of disseminated Lyme disease.
  26. Performing sinus imaging studies for patients with acute rhinosinusitis in the absence of predisposing factors for atypical microbial causes.
  27. Performing imaging studies in patients with recurrent, classic migraine headache and normal findings on neurologic examination.
  28. Performing brain imaging studies (CT or MRI) to evaluate simple syncope in patients with normal findings on neurologic examination.
  29. Routinely performing echocardiography in the evaluation of syncope, unless the history, physical examination, and electrocardiogram do not provide a diagnosis or underlying heart disease is suspected.
  30. Performing predischarge chest radiography for hospitalized patients with community–acquired pneumonia who are making a satisfactory clinical recovery.
  31. Obtaining CT scans in patients with pneumonia that is confirmed by chest radiography in absence of complicating clinical or radiographic features.
  32. Performing imaging studies, rather than a high–sensitivity–D–dimer measurement as the initial diagnostic test in patients with low pretest probability of venous thromboembolism.
  33. Measuring D–dimer rather than performing appropriate diagnostic imaging (extremity ultrasonography, CT angiography, or ventilation–perfusion scintigraphy in patients with intermediate or high probability or venous thromboembolism)
  34. Performing follow–up imaging studies for incidentally discovered pulmonary nodules <= 4 mm in low–risk individuals.
  35. Monitoring patients with asthma or chronic obstructive pulmonary disease by using full pulmonary function testing that includes lung volumes and diffusion, capacity, rather than spirometry alone (or peak expiratory flow rate monitoring in asthma).
  36. Performing an antinuclear antibody test in patients with nonspecific symptoms, such as fatigue and myalgia, or in patients with fibromyalgia.
  37. Screening for chronic obstructive pulmonary disease with spirometry in individuals without respiratory symptoms.

*Tests are listed in no particular under.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

American College of Physicians: Common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high–value care

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

3rd eMedinewS RevisitinG 2011

Dr Alka Kriplani, Professor and Head of Unit II, Dept of Obstetrics and Gynecology, AIIMS was awarded with eMedinewS Medical Statesman of the Year 2011 Award in the 3rd eMedinewS RevisitinG 2011

Dr K K Aggarwal
    National News

Govt plans to add TB to notifiable diseases list

MUMBAI: The state government is considering a proposal to include TB in the list of notifiable diseases, which will make it mandatory for private hospitals, clinics and laboratories to report al TB cases to the government. "The BMC can make it a notifiable disease within corporation limits. But for a more comprehensive approach, the state and central governments plan to bring TB in the list of notifiable diseases," said Manisha Mhaiskar, additional municipal commissioner (health). The decision comes following the detection of extra–extensively drug–resistant TB cases in Mumbai. "At present the civic administration is getting all details of the TB cases from the two accredited and nine unaccredited testing laboratories," Mhaiskar added. (Source: TOI, Jan 23, 2012)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

Smoke-activated cells ravage lungs in emphysema

The destruction of lung tissue in emphysema was mediated by antigen–presenting cells (APCs) that were activated by the smoke, according to an experimental study. (Source: Medpage Today)

For comments and archives

Washington Week: FDA says no to diabetes drug

The FDA rejected an investigational diabetes drug because of cancer concerns, and the Department of Health and Human Services (HHS) gave religious organizations another year to comply with a birth control provision of the healthcare reform law. (Source: Medpage Today)

For comments and archives

FDA Panel rejects gel to prevent preterm birth

An FDA advisory panel has voted 13–4 against recommending approval for a vaginal progesterone gel, deciding that although the gel is safe, it does not appear to be more effective at preventing preterm birth than placebo. The progesterone gel was developed by Watson Pharmaceuticals and Columbia Laboratories, which are seeking marketing approval for the gel to prevent premature labor in women with a shorter–than–normal cervix (≤3 cm at 24 weeks’ gestation). Short cervix length is a well–known risk factor for preterm births. (Source: Medpage Today)

For comments and archives

FDA OKs PML risk test for patients on Tysabri

The FDA has approved the first test for assessing the risk of progressive multifocal leukoencephalopathy (PML) in patients on natalizumab (Tysabri). The Stratify JCV Antibody ELISA test screens for the presence of antibodies to the JC virus, a risk factor for PML in patients with multiple sclerosis or Crohn's disease who are taking the monoclonal antibody, the agency said in a statement. (Source: Medpage Today)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: #AJD Clinic prevalence and risk analysis of early–onset T2DM among rural Indian Diabetic population. AJD Vol 13…fb.me/1GhCooJHI

@DeepakChopra: CosmicConsciousness The light of consciousness makes the world visible. Without consciousness it remains unmanifest

    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Bhishma Ashtami

Bhishma (Mahabharata) was the youngest son of King Shantanu and Ganga. Shantanu married Ganga with the condition that Shantanu would never question her. Eight children were born to this union, the eighth of which was Bhishma himself. The seven siblings born before him were drowned by

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, IVF expert, New Delhi)

Which precautions should women take while carrying a twin pregnancy?

Women carrying a multiple pregnancy may need to spend weeks or even months in bed or in the hospital in an attempt to delay preterm delivery. The risk of preterm delivery in multiple pregnancies is high, and babies may be born too early to survive. Premature babies require prolonged and intensive care and risk lifelong handicaps due to premature birth.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

A Strong Woman vs Woman of Strength

A strong woman works out every day to keep her body in shape… but a woman of strength kneels in prayer to keep her soul in shape…

A strong woman isn’t afraid of anything… but a woman of strength shows courage in the midst of her fear…

A strong woman won’t let anyone get the best of her… but a woman of strength gives the best of her to everyone…

A strong woman makes mistakes and avoids the same in the future… a woman of strength realizes life’s mistakes can also be God’s blessings and capitalizes on them…

A strong woman walks sure footedly… but a woman of strength knows God will catch her when she falls…

A strong woman wears the look of confidence on her face… but a woman of strength wears grace… A strong woman has faith that she is strong enough for the journey… but a woman of strength has faith that it is in the journey that she will become strong…

For comments and archives

   Cardiology eMedinewS

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

CIN–requiring dialysis did not occur in any patient who had a mean urine flow >150 mL/h

Read More

Good nutrition keeps brain in shape

Read More

Cognitive decline begins in mid–life

Read More

Pulmonary pressure prognostic in heart failure

Read More

   Pediatric eMedinewS

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Dr. Jaydeep Choudhury, Organizing Secretary, PEDICON 2013

Read More

Dr. Anjan Bhattacharya, Chairman, Medicolegal Cell

Read More

When does a complication become a negligence: Dr PK Kohli

Read More

    Healthy Driving

(Conceptualized by Heart Care Foundation of India and Supported by Transport Department; Govt. of NCT of Delhi)

Distance vision can also be affected by the state of your windscreen and glasses. These should be kept clean and free of dust and scratches, which can greatly reduce vision on bright days and at night.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with inflammation was on regular follow up.
Dr. Bad: Do sequential ESR.
Dr Good: Do sequential CRP.
Lesson: As the patient’s condition worsens or improves, the ESR changes relatively slowly but the CRP concentrations changes rapidly.

For comments and archives

Make Sure

Situation: A patient’s blood pressure was not responding to Arkamin.
Reaction: Oh my God! Why was the patient given Artamin?
Lesson: Make sure that prescription is written with the drug name spelled clearly.

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  Quote of the Day

(Dr GM Singh)

Inventing is the mixing of brains and materials. The more brains you use, the less materials you need. Charles F. Kettering

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Prostate specific antigen (PSA)

Ejaculation can increase PSA levels by upto 0.8 ng/mL, though levels return to normal within 48 hours. There is no need to ask men to abstain from sexual activity prior to PSA measurement. However, if an initial measurement is high enough to potentially prompt an intervention (i.e., biopsy), but close to a borderline value, it is appropriate to repeat the PSA measurement after having the man abstain from ejaculation for at least 48 hours.

    Mind Teaser

Read this…………………

you cont ol r

Yesterday’s Mind Teaser: death…………life

Answer for Yesterday’s Mind Teaser: life after death

Correct answers received from: Dr Prabha Sanghi, Dr Anupam Sethi Malhotra, Dr Indu Sharma, Ritu Sinha, Dr Mrs S Das, Dr PC Das, Dr T Samraj, Dr Chandresh Jardosh, Dr HL Kapoor, Raju Kuppusamy, Muthumperumal Thirumalpillai, Dr Vijay Kansal, Dr Neelam Nath, Anil Bairaria, Rajiv Sridharan.

Answer for 22nd January Mind Teaser: long time no "c"
Correct answers received from: Raju Kuppusamy, Theogaraj Samraj.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

"Doctor Doctor – I feel like a pack of cards!"
"I’ll deal with you later."

  Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Estimation of bone age

  • The lower end of radius bone fuses at the age of 16–17 years in male; in the case of female it fuses at the age of 17–18 years.
  • The lower end of ulna fuses at the age of 18 years in case of male and in case of female it fuses at the age of 17 years.
  • If the fusion of radius and ulna is seen in both, the attainment of age of 18 years cannot be ruled out.
  • To be radiologically more specific and precise as recommended for forensic opinion, an X–ray of hip bone for crest of ilium and ischial tuberosity should be done since their fusion in male or female occurs between 18–20 years.
  • The radiological examination for appearance and fusion of ossification centre of left hand if the person is right–handed and vice–versa should be advised/ considered more safely by doctor since it gives more reliable radiological picture due to less wear and tear.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Taking Calcium supplements–Is it safe?

Taking calcium supplements can increase kidney stones. However, the same calcium taken in the diet reduces the incidence of kidney stone formation, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Calcium supplements have been recommended for the elderly, especially by post menopausal women to reduce the chances of osteoporosis. There have been conflicting reports as to how much calcium intake one should take in the form of supplements.

A study has shown that an intake of calcium between 1000–1500 mg can raise the chances of heart disease in post menopausal women. This study is in conflict to earlier studies which have shown that taking regular calcium supplements reduce blood pressure and serum cholesterol levels.

A patient should continue to take calcium supplements of 500 mg/day, when indicated.

    Readers Response
  1. Dearest Brother Dr. KK ji, Hardly can I find words to express my gratitude to you for a GREAT DAY that dawned on earth today and the horizon of Medical Profession. You are TRUELY THE SON OF SOIL. I can only say "God bless You"…and may you continue ENRICHING ENTIRE HUMANITY. We at Mission Jan Jagriti Blood Bank, which works with 100% voluntary blood donations and does not ask any replacement, would feel honored to get associated with your esteemed organization, for promotion of Voluntary Blood Donations in Delhi and make it 100% under the able guidance of Dr. Bharat Singh, Director SBTC Delhi. I would also like to appeal and request all worthy colleagues that they can depend on us for Quality Services to their patients. Regards: Dr. NK Bhatia.
    Forthcoming Events


The Annual conference of Indian Menopause Society is to be held from 17 to 19th Feb 2012 in Hotel The Claridges, Surajkund Faridabad. It is multidisciplinary approach to the problems of midlife onwards in women. This conference has participation of British Menopause Society and South Asian Federation Of Menopause Societies and opportunity to hear from international faculties.

For information Contact Dr. Maninder Ahuja (Organizing Chairperson) 9810881048 down load forms from web sit http://indianwoman35plus.com/ or Indianmenopausesociety.org or http://fogsi.org/

Contact at ahuja.maninder@gmail.com
Call for free papers and posters on theme topics of conference.

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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta